Health, family and romance problems appear to be the particular life stressors most associated with increased risk for using opioids to cope, and individuals with low self-esteem appear to be at risk for these connections, according to a new paper including researchers at Binghamton University, State University at New York.

The research team, which included Binghamton University graduate student Damla Aksen, surveyed 1,000-plus adults about five life stressors, self-esteem and indications of opioid use. Examining the data, they found that poor self-esteem was associated with high opioid use and that poor self-esteem was a significant mediator between each life stressor (health, family, romance) and increased risk for opioid use.

“Although we cannot make conclusions about underlying physiology from our present study, past research indicates that individuals who experience social rejection are at increased risk for low self-esteem and depression, with reduced serotonin and dopamine functioning in their brains,” said Aksen. “Because opioids increase the effects of dopamine and serotonin in the brain, consuming them provides a rapid and powerful change in the neurochemistry underlying depression and the low self-esteem that it often includes. In other words, opioids may serve as self-medication in response to social stressors and its cascade of negative consequences.”

Because health, family or romance stressors appear to be associated with an increased risk for opioid abuse, individuals who use opioids could seek services and programs that help them learn how to cope with these particular stressors, said Aksen. They could also seek counselors and services that guide them to manage stress and improve their self-esteem with other research-documented coping strategies, such as exercise, social support, and altruism. She also noted that professionals working with individuals who use opioids could also be mindful of the risk factors that contribute to opioid abuse and educate these individuals about the life stressors that contribute to vulnerability for opioid abuse.

“Results from this new study suggest that one-size-does-not-fit-all when it comes to the particular life stressors that increase an individual’s risk for opioid abuse,” said Aksen.

The present sample included mostly individuals with a White ethnic identity and high incomes, so future research should examine these patterns with more diverse samples, wrote the researchers.